不同时期重症急性胰腺炎治疗的对照研究

Control Study of Treatments for Severe Acute Pancreatitis During Different Periods

目的评价不同时期重症急性胰腺炎(severe acute pancreatitis,SAP)治疗的疗效。方法纳入1986年1月至2009年10月期间我院收治的234例SAP患者,按SAP收治时间的先后将其分为两个阶段:第一阶段为1986年1月至1998年8月(早期组,n=117),第二阶段为1998年9月至2009年10月(近期组,n=117),2组一般临床资料具有可比性。早期组主要施行手术和药物治疗,近期组施行多种方法联合治疗。比较2组患者的住院时间、治愈率及死亡率;住院治疗期间假性胰腺囊肿、胰腺及胰周脓肿、胰性脑病、心功能不全、急性肾功能衰竭(ARF)、急性呼吸窘迫综合征(ARDS)及休克发生率;并对2组早期治疗患者的结果以及腹腔积液、胆源性胰腺炎和胰腺及胰周并发症的治疗结果进行分层对比。结果与早期组比较,近期组的住院时间短(P<0.05)、治愈率高(P<0.001)及死亡率低(P<0.001)。近期组治疗期间假性胰腺囊肿、胰腺及胰周脓肿、胰性脑病、心功能不全、ARF、ARDS及休克发生率均低于早期组(P<0.05)。根据分层对比结果,近期组采用早期治疗以及腹腔积液、胆源性胰腺炎和胰腺及胰周并发症的治愈率均高于早期组(P<0.001)。结论近年SAP治疗模式的改变明显提高了SAP的治疗效果。

Objective To evaluate the therapic efficacy for severe acute pancreatitis（SAP） during different periods.Methods According to internalized standard,234 patients with SAP admitted to this hospital from January 1986 to October 2009 were included,which were divided into two stages based on the time of admitting to this hospital.The first stage named prior operation group was from January 1986 to August 1998（n=117）,the second stage named individual treatment group was from September 1998 to October 2009（n=117）.There was comparability in demography and clinic between two groups.The prior operation group primarily underwent laparotomy and medication,and the individual treatment group underwent multiple combined therapies.These indexes were compared between two groups： hospital stay,cure rate,and mortality;the incidences of pancreatic pseudocyst,pancreatic and peripancreatic abscess,pancreatic encephalopathy,cardiac insufficiency,acute renal failure（ARF）,acute respiratory distress syndrome（ARDS）,and shock.The efficacies for early treatment,ascites,biliary pancreatitis,and pancreatic and peripancreatic complications were compared two groups by stratified analysis.Results Compared with the prior operation group,the hospital stay was shorter（P0.05）,cure rate was higher（P0.001）,and mortality was lower in the individual treatment group（P0.001）.During the treatments,the incidences of pancreatic pseudocyst,pancreatic and peripancreatic abscess,pancreatic encephalopathy,cardiac insufficiency,ARF,ARDS,and shock in the individual treatment group were lower than those in the prior operation group（P0.05）.According to the stratified analysis,the efficacies for early treatment,ascites,biliary pancreatitis,and pancreatic and peripancreatic complications in the individual treatment group were better than those in the prior operation group（P0.001）.Conclusion In recent years,the change of therapeutic mode significantly improves the treatment efficacy for SAP.